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Semester 5 PMNM Exam 8 > Spinal Cord Injury 1 > Flashcards

Spinal Cord Injury 1 Flashcards

1
Q

SCI most common cause

A

MVC

Falls is next

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2
Q

Mechanism of Injury

A

Hyperflexion
Hyperextension
Compression
Excessive lateral bending or rotation

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3
Q

Mechanism of Injury - Hyperflexion

A

Post ligament tears and dislocates

Complete SCI in about 1/3 of flexion injuries

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4
Q

Mechanism of Injury - Hyperextension

A

Anterior ligament tears

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5
Q

Mechanism of Injury - compression

A

Crushing of vertebrae
Bony fragments can go into spinal cord and cause damage
75% chance of complete SCI

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6
Q

Mechanism of Injury - Trauma - Transection causes

A

Glia disrupted
Spinal cord tissue torn
Can be caused by penetrating trauma, blunt trauma, bony fragment, disc herniation

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7
Q

Mechanism of Injury - Compression causes

A

Violent shaking or direct blow

Temporary loss of function

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8
Q

Mechanism of Injury - Contusion

A

Glial tissue and spinal cord surface are intact
May have loss of central grey and white matter
Created cavity with white matter rim at periphery

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9
Q

Mechanism of Injury - Vascular Injury

A

Suspect if discrepancy between clinical neuro deficit and level of spinal injury

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10
Q

Mechanism of Injury - Vascular injury - examples

A

Lower cervical dislocation compresses vertebral arteries within spinal foramina of vertebrae
Thrombosis

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11
Q

Pathophysiology - Primary injury

A

Damage that occurs immediately at time of injury

Spared tissues and axons may remain and are important in recovery

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12
Q

Pathophysiology - Primary injury - Forces

A 
Compression
Contusion
Shear
Penetrating 
Gun shot wound that does not enter the spinal cord
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13
Q

Pathophysiology - Secondary injury

A

Begins within minutes
Evolves over hours
Can be from:
Ischemia, hypoxia, inflammation, edema, electrolyte disturbances

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14
Q

Pathophysiology - Secondary Injury - examples of electrolyte distrubances

A

Intracellular Ca inc
Extracellular K inc
Na permeability inc

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15
Q

Pathophysiology - Secondary injury - Blood flow changes

A 
Within 2 hours
Dec spinal cord blood flow
Rapid swelling at injury level
Pressure on cord becomes higher than venous pressure
Ischemia 
Necrosis
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16
Q

Pathophysiology - Secondary injury - Edema occurs

A

Within hours of injury

First and injury site and then spreads to adjacent and distant segments

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17
Q

Clinical Presentation

A

Depend on mech of injury
Typically pain at injury site, but not always
Often associated brain and systemic injuries
About 1/2 of traumatic SCI are cervical

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18
Q

Treatment of SCI - initial treatment is what

A

C spine immobilization!
CABs
Full spine immobilization

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19
Q

Clearing airways with pt with SCI

A

Modified jaw thrust to make sure to keep C spine in line

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20
Q

SCI - Consults

A 
Neurosurgeon
Orthopedics
Trauma specialist
General surgeon
Others as needed
An patient will be admitted
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21
Q

SCI - imaging

A

X ray
CT
MRI

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22
Q

SCI - Clinical localization - Complete cord injury

A

Transection of cord that can come from severe compression, or extensive vascular dysfunction
Complete loss of sensory and motor function below level of lesion

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23
Q

SCI - Clinical localization - Complete cord injury - ASIA grade

A

A

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24
Q

SCI - Clinical localization - Complete cord injury - Acute stages

A 
Absent reflexes
No response to plantar stimulation
Flaccid mm tone
Male - priapism
Urinary retention and bladder distension
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25
SCI - Clinical localization - Incomplete cord injury
Contusions, edema, bony fragments | Partial loss of sensory and motor function below level of lesion
26
SCI - Clinical localization - Incomplete cord injury - ASIA grade
B to D
27
SCI - Clinical localization - Incomplete cord injury - sensation and motor function
Various degrees of muscle motor function Various degrees of sensation in dermatomes Usually sensation is preserved more than motor function
28
SCI - Neurological level and completeness of injury with recovery
More incomplete the injury = more favorable the potential for recovery Esp. on initial eval at 72 hrs to 1 wk after injury
29
SCI - Deficits determined by neurologic levels/lesions
Tetra/Quad - spinal cord segment C1-C8 | Para - Thoracic, lumbar, or sacral segments
30
Spinal Cord Syndrome - Central Cord Syndrome
Damage central part of SC | Peripheral fibers not affected
31
Spinal Cord Syndrome - Central Cord Syndrome - often caused by
Often from cervical hyperextension with pre existing cervical spondylosis
32
Spinal Cord Syndrome - Central Cord Syndrome - s/s
More severe motor impairments in UE then LE Bladder dysfunction Variable sensory loss below injury level
33
Spinal Cord Syndrome - Central Cord Syndrome - s/s with tracts
Loss of pain and temp at site of injury and surrounding dermatome due to crossing of spinothalamic Dermatome above and below will have intact pain and temp Vibration and proprio often spared
34
Spinal Cord Syndrome - Anterior Cord Syndrome -
Often due to loss of blood supply from anterior spinal artery
35
Spinal Cord Syndrome - Anterior Cord Syndrome - Corticospinal tract
Weakness and reflex changes | bilateral loss motor function
36
Spinal Cord Syndrome - Anterior Cord Syndrome - Spinothalamic
Pain and temp loss bilaterally
37
Spinal Cord Syndrome - Anterior Cord Syndrome - Tactile, position, and vibratory sense
Normal
38
Spinal Cord Syndrome - Anterior Cord Syndrome - Caused by
Flexion injuries Intervertebral disc herniation Spinal cord infarction Radiation myelopathy
39
Spinal Cord Syndrome - Posterior Cord Syndrome - Causes
MS, Friedreich ataxia, tabes dorsalis | Tumors, cervical spondylotic myelopathy
40
Spinal Cord Syndrome - Posterior Cord Syndrome - Corticospinal
If actue - weakness, muscle flaccidity, hyporeflexia | If chronic - mm hypertonia, hyperreflexia
41
Spinal Cord Syndrome - Posterior Cord Syndrome - s/s
Loss of proprioception - wide based gait ataxia Loss of vibratory sensation Bladder dysfunction Paresthesias
42
Spinal Cord Syndrome - Brown Sequard syndrome
Unilateral involvement Dorsal column CST, spinothalamic tract
43
Spinal Cord Syndrome - Brown Sequard syndrome - s/s
Weakness, loss of vibration and prop (same side) | Loss pain and temp (opp side)
44
Spinal Cord Syndrome - Brown Sequard syndrome - causes
Knife or gunshot wound Demyelination Disc herniation, infarction, infection, tumors
45
Spinal Cord Syndrome - Conus Medullaris syndrome
``` Sacral cord injury L2 lesion - often affects conus medullaris Early prominent sphincter dysfunction Flaccid paralysis of rectum and bladder Impotenence Saddle anesthesia Leg muscle weakness (mild) ```
46
Spinal Cord Syndrome - Conus Medullaris syndrome - causes
Disc herniation Spinal fracture Tumors
47
Spinal Cord Syndrome - Cauda Equina Syndrome
Medical Emergency! Injury of LS nerve roots Loss of function of 2 or more of the 18 nerve roots in the cauda equina Usually central lumbar disc herniation Low back pain with radiation to one or both legs Weakness of PF with loss of ankle jerks Bladder and rectal sphincter paralysis (usually S3 to 5) Sensory loss in dermatomes of affected nerve roots Saddle anesthesia
48
Spinal Cord Syndrome - Cauda Equina Syndrome- what do you do
True medical emergency! | Refer to neurosurgery
49
Spinal Cord Injury - Syringomyelia - how many para and how many tetra
2% of para 0.2% of tetra Is a clinical syndrome
50
Spinal Cord Injury - Syringomyelia - most commonly seen where
Thoracic area
51
Spinal Cord Injury - Syringomyelia - Caused by
Cystic cavitation and gliosis of SC | Cysts may grow and become tubular to extend additional spinal levels
52
Spinal Cord Injury - Syringomyelia - occurs commonly when
Within 4-9 years post trauma | Can develop up to 30 years after initial lesion though
53
Spinal Cord Injury - Syringomyelia - S/S
Initially sharp pain Might have LMN dysfunction Sensory loss is common Horners syndrome (ipsilateral ptosis, miosis, anhydrosis)
54
Spinal Cord Injury - Syringomyelia - S/S that they may have
``` spasms reflex changes phantom sensations sexual dysfunction spasticity of mm mm wekaness cape like distribution HA b/b control loss sensation loss in hands ```
55
SCI - Neurapraxia
``` Transient neuro deficits Transient tetra (from axial loading Athletic injuries common Sudden decrease in AP diameter of the spinal canal - compression of cord Seen both with hyperext and flex ```
56
SCI - complications
``` Cardiac Resp. DVT Autonomic Dysreflexia Spasticity Integumentary B/B dysfunction ```
57
SCI - reflexes
Initial loss of function and reflex function 1st 2-3 wks - no spinal reflexes Slowly over time hyperreflexia when the mm tone inc Spasticity can develop
58
SCI - Spinal Shock
Transient physiological deficit of cord function below level of injury Complete loss of neuro function
59
SCI spinal shock - s/s
Initially - tachycardia and HTN - due to catecholamine release Bradycardia, hypotension Paralysis, b/b dysf, priapism
60
SCI - neurogenic shock
Severe autonomic dysfunction Interruption of sympathetic nervous system Usually does not occur with injury below T6
61
SCI neurogenic shock - ss
``` Hypotension Bradycardia Peripheral VD Hypothermia Priapism Dec temp reg below injury B/B incontinence ```
62
Shock with spinal cord injury below T6
Consider hemorrhagic until proven otherwise!
63
Management SCI
Loss of sympathetic tone | Due to loss of vascular tone so can be mildly hypotensive or mildly bradycardic
64
Management SCI - Goal
Ideal MAP at least 90 Fluids but not over Vasopressors (dopamine) Maintain blood supply to spinal canal
65
SCI - BP for injuries above T6
Baseline BP is reduced | Baseline HR is reduced (50-60)
66
SCI - BP for injuries above T6 - consideration
Hemodynamic instability | Exercise intolerance
67
SCI - orthostatic hypotension
Need to have evaluated BP and pulse Dec sys BP more than 20 Dec dias BP more than 10
68
SCI - orthostatic hypotension - Chronic SCI
Excessive bed rest | Diminished fluid intake
69
SCI - orthostatic hypotension - s/s
dizzy | lightheaded
70
SCI - orthostatic hypotension - tx
``` Place them in supine If able to raise legs Tup wc to lower head Assess vitals Assess s/s ```
71
SCI - orthostatic hypotension - prevention
Gradual change positions | Dec venous pooling - TED hose, abdominal binders
72
Cardiovascular complications - Autonomic Dysreflexia
Medical emergency!! Occurs in SCI above T6 Uninhibited sympathetic response to stimuli Leads to diffuse VC and causes HTN so then they Compensate with parasympathetic response above lesion (brady, VD) but not enough to compensate for symp response
73
Cardiovascular complications - Autonomic Dysreflexia - frequency
20-70% of patients with SCI lesions above T6
74
Cardiovascular complications - Autonomic Dysreflexia - when seen
Unusual to be seen in first month | Usually seen within first year
75
Cardiovascular complications - Autonomic Dysreflexia - Stimuli
``` Bladder distension Bowel impaction Pressure sores Bone fracture Occult visceral disturbances Sexual activity Gynecological - labor, delivery, menstruation ```
76
Cardiovascular complications - Autonomic Dysreflexia - s/s
``` HA HTN Brady Diaphoresis Flushing Piloerection Blurred vision Nasal obstruction Anxiety Nausea ```
77
Cardiovascular complications - Autonomic Dysreflexia - complications
``` Asymptomatic HTN HTN crisis Brady Cardiac arrest Intracranial hemorrhage Seizures ```
78
Cardiovascular complications - Autonomic Dysreflexia - severity and frequency
depends on SCI
79
Cardiovascular complications - Autonomic Dysreflexia =
LIFE THREATENING! | Med emergency
80
Cardiovascular complications - Autonomic Dysreflexia - management
``` Check BP If safe, sit them up Remove tight clothes Search for cause - check urinary catheters Meds if needed ```
81
Cardiovascular complications - Autonomic Dysreflexia - management - medications
``` Nitrates Nifedipine Captopril Hydralazine Labetalol ```
82
Cardiovascular complications - Autonomic Dysreflexia - what is key
Recognize it and avoidance of causative stimuli
83
Cardiovascular complications - CAD - incidence
3-30 times more with SCI patient
84
Cardiovascular complications - CAD - risk factors
``` Lipid profile (low H, High L) Glucose metabolism (impaired glucose tolerance, insulin resistance, diabetes) ```
85
Cardiovascular complications - CAD - contributing factors
Dec mm mass Inc fat Inactivity
86
Cardiovascular complications - CAD - mortality
``` Greater in SCI patients Lesions above T5 Atypical s/s cardiac ischemia Autonomic dysreflexia Changes in spasticity ```
87
Cardiovascular complications - CAD - cardiac arrhythmias
Acute - due to excess vagal tone, hypoxia, hypotension, fluid and electro imbal Less frequent with chronic Complete - ongoing risk factor of cardiac arrest
88
Pulmonary complications - ventilatory function
Resp mm impacted (cervial and high thoracic) Need for assisted vent depends on level and severity of SCI Dyspnea Exercise intolerance Impaired cough Lung secretions Inc risk of pneumonia
89
Pulmonary complications - DVT
Common early complication Often from lack of movement PE leads to death
90
Pulmonary complications - DVT - Prevention
``` Exercise - early mob Turning in bed Prophylactic use of heparin for at least first 3 months TED hose Sequential compression devices Foot pumps IVC filter ```
91
Pulmonary complications - DVT - S/S
``` Calf pain Edema or swelling Warmth Tenderness Erythemia Palpable cord Homans sign is unreliable All of these are nonspecific ```
92
Pulmonary complications - DVT - What do you do if you think there is one
Stop mob Report findings Doppler US Blood tests
93
Temp Regulation complication due to
disruption of autonomic pathways they have trouble regulating their temp
94
Temp Regulation complication - most vulnerable
SCI T6 and above
95
Temp Regulation complication - impaired ___ mechanism
Cooling Loss of sympathetic system - Insensate skin - impaired vasomotor and sudomotor (sweat gland) responses - Reduced sweating Autonomic dysfunction below lesion and limited or loss of skeletal muscle pump action (paralysis) - Impaired redistribution of blood - Decreased venous return Increased metabolic heat – exercising muscles
96
Temp reg comp - conditions
``` Exercise - hyperthermia Hot ambient temp - hyperthermia Cold ambient temp - hypothermia Infection Episodic hyper or hypothermia ```
97
Temp reg complication - Tx - depends on condition - Hyperthermia
Remove from hot environment Heat cramps Heat exhaustion Heat stroke - med emergency
98
Temp reg complication - Tx - depends on condition - hypothermia
``` Core body temp below 95F Remove from cole environ Passive external rewarming If mod or severe get med attn Monitor closely ```
99
Urinary complications - Bladder dysfunction
Affects urine storage and emptying | 2 types - spastic or flaccid bladder
100
Urinary complications - Bladder dysfunction - target
bladder volume less than 500 ml to avoid distension
101
Urinary complications - Bladder dysfunction - Urinary incontinence - management
Short term - can use condom catheters or adult diapers Rule out infection - UTI Adjust cath frequency and amount of fluid intake Med
102
Urinary complications - Bladder dysfunction - Urinary incontinence - meds
Anticholinergics Alpha adrenergics Cholinergics Alpha blockers
103
Surgical management
``` Anterior cervical discectomy with fusion Laminectomy Discectomy Fusion Combinations ```
104
Advances in care
Epidural spinal cord stimulation Exoskeleton Stem cell
105
Epidural spinal cord stimulation
Neurostimulator and leads that run up the spinal cord Implanted in abdomen Delivers electrical signals to epidural space Stops pain messages from reaching brain

Semester 5 PMNM Exam 8 (8 decks)

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